4th Global Symposium on Health Systems Research

The WHO Global Strategy on Human

Resources for Health

and the

UN Commission on Health Employment and

Economic Growth

Vancouver, Canada, 14 November, 2016

Giorgio Cometto, Health Workforce Department, WHO

SDG 3 - HEALTH

Health Labour Market Framework for UHC

Demand

SDG Index 4.45 (midwives, nurses and physicians) per 1,000 population

Supply Need

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Insufficient supply to meet needs (needs-based shortage)

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Insufficient demand to employ workforce to meet population needs (market failure)

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Insufficient supply to meet demand (economic shortage)

Need, supply and demand for health workers

Stock Needs-based shortage Labour market demand

2013 2030 % change 2013 2030 % change 2013 2030

Income

High 17.6 24.3 38% 0.1 0.1 -7% 17.7 23.8

Upper-middle 14.7 22.6 54% 3.7 1.8 -50% 19 33.3

Lower-middle 10 18.3 82% 9.1 6.6 -28% 10.9 21.7

Low 1.1 2.1 86% 4.6 6.1 33% 0.6 1.4

Region 0

Africa 1.9 3.1 63% 4.2 6.1 45% 1.1 2.4

Americas 9.4 14 50% 0.8 0.6 -17% 8.8 15.3

Eastern Mediterranean 3.1 5.3 72% 1.7 1.7 -1% 3.1 6.2

Europe 12.7 16.8 32% 0.1 0.1 -33% 14.2 18.2

South-East Asia 6.2 10.9 75% 6.9 4.7 -32% 6 12.2

Western Pacific 10.3 17.3 68% 3.7 1.4 -64% 15.1 25.9

World 43.5 67.3 55% 17.4 14.5 -17% 48.3 80.2

All health worker figures in millions, rounded to nearest 100,000

Stock and shortage figures refer to 193 Member States

(Source: WHO Global Strategy on HRH http://who.int/hrh/resources/globstrathrh-2030/en/ )

Labour market demand figures refer to 165 Member States with sufficient data (source: World Bank)

Projected trends to 2030

Global economy is projected to create around 40 million new health sector jobs by 20301

1 World Bank . 2 World Health Organization

High income

Upper-middle income

Lower-middle income

Low income

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Projected shortage of 18 million health workers to achieve and sustain the SDGs2

A supply – demand mismatch

The Global Strategy on HRH: Workforce 2030

1. Optimize the existing workforce in pursuit of the Sustainable Development Goals and UHC (e.g. education, employment, retention)

2. Anticipate and align investment in future workforce requirements and plan the necessary changes (e.g. a fit for purpose, needs-based workforce)

3. Strengthen individual and institutional capacity to manage HRH policy, planning and implementation (e.g. migration and regulation)

4. Strengthen data, evidence and knowledge for cost-effective policy decisions (e.g. National Health Workforce Accounts)

The Global Strategy on HRH: Workforce 2030

Objective 1: Optimize performance, quality and impact of the health workforce through evidence-informed policies on human resources for health, contributing to healthy lives and well-being, effective universal health coverage, resilience and strengthened health systems at all levels Milestones: 1.1 By 2020, all countries will have established accreditation mechanisms for health training institutions. 1.2 By 2030, all countries will have made progress towards halving inequalities in access to a health worker. 1.3 By 2030, all countries will have made progress towards improving the course completion rates in medical, nursing and allied health professionals training institutions.

The Global Strategy on HRH: Workforce 2030

Objective 2: Align investment in human resources for health with the current and future needs of the population and health systems, taking account of labour market dynamics and education policies, to address shortages and improve distribution of health workers, so as to enable maximum improvements in health outcomes, social welfare, employment creation and economic growth Milestones: 2.1 By 2030, all countries will have made progress towards halving their dependency on foreign-trained health professionals, implementing the WHO Global Code of Practice on the International Recruitment of Health Personnel. 2.2 By 2030, all bilateral and multilateral agencies will have increased synergies in official development assistance for education, employment, gender and health, in support of national health employment and economic growth priorities. 2.3 By 2030, partners in the Sustainable Development Goals will have made progress to reduce barriers in access to health services by working to create, fill and sustain at least 10 million additional full-time jobs in health- and social-care sectors to address the needs of underserved populations. 2.4 By 2030, partners in the UN Sustainable Development Goals will have made progress on Goal 3c to increase health financing and the recruitment, development, training and retention of health workforce.

The Global Strategy on HRH: Workforce 2030

Objective 3: Build the capacity of institutions at subnational, national, regional and global levels for effective public policy stewardship, leadership and governance of actions on human resources for health Milestones: 3.1 By 2020, all countries will have inclusive institutional mechanisms in place to coordinate an intersectoral health workforce agenda. 3.2 By 2020, all countries will have an HRH unit with responsibility to develop and monitor policies and plans. 3.3 By 2020, all countries will have regulatory mechanisms to promote patient safety and adequate oversight of the private sector.

The Global Strategy on HRH: Workforce 2030

Objective 4: Strengthen data on human resources for health for monitoring and accountability of national and regional strategies, and the Global Strategy Milestones: 4.1 By 2020, all countries will have made progress to establish registries to track health workforce stock, education, distribution, flows, demand, capacity and remuneration. 4.2 By 2020, all countries will have made progress on sharing HRH data through national health workforce accounts and submitting core indicators to the WHO Secretariat annually. 4.3 By 2020, all bilateral and multilateral agencies will have strengthened health workforce assessment and information exchange.

The Power of Health Workers video: https://www.youtube.com/watch?v=TeP0aafYvH0

The Commission seeks to:

• Highlight the benefits across the SDGs from investments in the health workforce;

• Draw attention to the necessary reforms in health employment, education and service delivery;

• Generate political commitment and inter-sectoral action towards more and better investment in the health workforce.

The High-Level Commission on Health

Employment and Economic Growth

Agenda 2030 for Sustainable Development

Baumol (1967)

– Growth in health sector employment without increase in productivity could constrain economic growth (data from USA)

Hartwig (2008 and 2011)

– Confirmation of Baumol hypothesis (data from OECD countries)

Arcand et al., World Bank (In press, 2016)

– larger dataset; data from low-, middle- and high-income countries

– establishes positive and significant growth inducing effect of health sector employment; multiplier effect on other economic sectors

– magnitude of effect greater than in other recognized growth sectors

Health as a cost disease and a drag on the

economy

Health as a multiplier for inclusive economic

growth

HRH financing: cost or investment?

Growth in health and social sector employment throughout the economic downturn Around 42 million people across 34 countries of the Organisation for Economic Co-Operation and Development (OECD) were unemployed in May 2015, 10 million more than before the financial crisis (OECD Employment Outlook 2015)

A large and growing share of employment

A countercyclical source of employment (USA)

SOURCE: World Bank, 2014.

A countercyclical source of employment (LMIC)

Source: Human Development Report 2015: Work for Human Development

What about future employment?

Women's share of employment in the health and social sector

Women's share of employment in the economy

Source: Magar et al, WHO, based on ILOSTAT (forthcoming 2016)

What about women?

Case for investment Health is a leading

economic and labour sector.

67% of the health

workforce are women (compared to 41% of

total employment)

1/4 of economic growth 2000 to 2011, in low- and middle-income countries,

resulted from improvements in

health.

Return on investment estimated at 9:1.

Case for Investment

“The Commission concludes that, to the extent that resources are wisely spent and the right policies are put in place, investment in education and job creation in the health and social sectors will make a critical positive contribution to inclusive economic growth”. Prof . Joseph E. Stiglitz

Nobel laureate economist

Commission’s recommendations…

10 recommendations + 5 actions 1. Job creation 2. Gender equality and women's rights 3. Education training and competencies 4. Health service delivery and

organization 5. Technology 6. Crisis and humanitarian settings 7. Financing and fiscal space 8. Partnerships and cooperation 9. International migration 10.Data, information and accountability

Commission’s recommendations…

Recommendation #1 Stimulate investments in creating decent health sector jobs, particularly for women and youth, in the right numbers and in the right places.

Recommendation #2 Maximize women’s economic participation & foster their empowerment by institutionalizing their leadership, addressing gender biases & inequities in education & the health labour market, and tackling gender concerns in health reform processes.

Recommendation #3 Scale up transformative, high-quality education and lifelong learning so that all health workers have skills that match the health needs of populations and can work to their full potential.

Commission’s recommendations… Recommendation #4 Reform service models concentrated on hospital care & focus instead on prevention & the efficient provision of high-quality, affordable, integrated, community-based, people-centred primary & ambulatory care, paying special attention to underserved areas.

Recommendation #5 Harness the power of cost-effective information & communication technologies to enhance health education, people-centred health services and health information systems. Recommendation #6 Ensure investment in the International Health Regulations core capacities, including skills development of national & international health workers in humanitarian settings & public health emergencies, both acute and protracted. Ensure the protection and security of all health workers & health facilities in all settings.

Commission’s recommendations… Recommendation #7 Secure adequate funding from multiple domestic and other sources, including the private sector, and consider broad-based health financing reform where needed, to invest in the right skills, decent working conditions and an appropriate number of health workers.

Recommendation #8 Promote intersectoral collaboration at national, regional & international levels; engage civil society, unions & other health workers' organizations & the private sector; and align international cooperation to support investments in the health workforce, as part of national health & education strategies and plans.

Recommendation #9 Advance international recognition of health workers' qualifications to optimize skills use, increase the benefits from and reduce the negative effects of health worker migration, and safeguard migrants' rights.

Commission’s recommendations…

Recommendation #10 Undertake robust research and analysis of health labour markets, using harmonized metrics and methodologies, to strengthen evidence, accountability and action

Purpose:

To facilitate the standardization of a health workforce

information system for interoperability, and to support

tracking health workforce policy performance towards

universal health coverage.

.

http://www.who.int/hrh/documents/brief_nhwfa_handbook/en/

Commission: 5 immediate actions….

1. Secure commitments, foster intersectoral engagement and develop an implementation plan 1. ILO, OECD and WHO will convene a High-Level Ministerial

Meeting (14-15 Dec 2016) to agree a five-year implementation plan for the ten recommendations.

2. Galvanize accountability, commitment and advocacy

3. Advance health labour market data, analysis and tracking in all countries

4. Accelerate investment in transformative education, skills and job creation

5. Establish an international platform on health worker mobility

THANK YOU

who.int/hrh

#workforce2030